Provider Demographics
NPI:1932078789
Name:REVITALIZED HEALTH AND CHIROPRACTIC
Entity type:Organization
Organization Name:REVITALIZED HEALTH AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:WOERMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-769-7361
Mailing Address - Street 1:3802 EHRLICH RD STE 311
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2355
Mailing Address - Country:US
Mailing Address - Phone:813-336-2017
Mailing Address - Fax:
Practice Address - Street 1:3802 EHRLICH RD STE 311
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2355
Practice Address - Country:US
Practice Address - Phone:813-336-2017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty